R. Scherer, H. Ostermann, H. Forst, J. Eckart
Die postoperative Blutung
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Critical care, Surgery, operative, Hemmorrhage
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Summary: In the postoperative diffuse bleeding scenario any therapeutic effort is based on the assumption that there is no surgical means to stop bleeding. The diagnosis of the underlying mechanism differentiates a static from a dynamic haemostatic disorder. Whereas the static coagulation disorder is characterised by a decreased procoagulant and inhibitory coagulation potential which is stable (most likely : dilution), the dynamic haemostatic disorder reflects ongoing consumption of both coagulation factors and inhibitors due to blood loss or permanent activation. Global coagulation variables such as the prothrombin time, the activated partial thromboplastin time, fibrinogen concentration, platelet count, and antithrombin (AT) activity may indicate whether there is an increased turnover (progressive deterioration of all variables) or not. In order to avoid further deterioration of a static coagulation disorder when the patient is bleeding diffusely, fresh frozen plasma (FFP) should ideally be used to maintain plasmatic coagulation activity during red cell transfusion therapy. Increased turnover, however, should primarily be treated by coagulation inhibitor concentrates such as AT III, in particular prior to administration, of coagulation factor (platelets, prothrombin complex, fibrinogen).